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Case Management on Neonatal Mortality from Sepsis and Pneumonia

Reference
Zaidi AKM, Ganatra HA, Syed S, Cousens S, Lee AC, Black RE, Bhutta ZA, Lawn JE.  Effect of case management on neonatal mortality due to sepsis and pneumonia.  BMC Public Health 2011; 11 (Suppl 3): S13.

Background

  • Annually, neonatal deaths account for 41% (3.6 million) of all deaths in children under 5 years of age. (1)
  • The majority of these deaths occur in low income countries and almost 1 million of these deaths are attributable to infectious causes including neonatal sepsis, meningitis and pneumonia. (1)
  • Therapy with appropriate antibiotics and supportive management in neonatal nurseries in the cornerstone of management of neonatal sepsis and pneumonia, with strong biological plausibility that such therapy saves lives.

Intervention Effects

Treatment of Neonatal Pneumonia with Oral Antibiotic Therapy Alone on All-cause Mortality

  • 25% reduction (RR: 0.75, 95% CI: 0.64-0.98) in all-cause mortality
  • Based on meta-analysis of 4 studies in community-based settings (moderate quality of evidence)
  • 42% reduction (RR: 0.58, 95% CI: 0.41-0.82) in pneumonia-specific mortality
  • Based on meta-analysis of 3 studies in community-based settings (moderate quality of evidence)

Treatment of Neonatal Pneumonia with Oral Antibiotic Therapy Alone on Sepsis-specific Mortality

  • No studies were identified evaluating oral antibiotics in community-based settings for sepsis-specific mortality
  • 28% (IQR: 20-36.25%) reduction for oral antibiotics on sepsis-specific mortality– Delphi consensus of 20 experts (very low quality of evidence)

Community-based Neonatal Care Packages (including injectable antibiotics) on Mortality

  • 44% reduction (RR: 0.56, 95% CI: 0.41-0.77) in all cause-mortality – 2 studies
  • 34% reduction (RR: 0.66, 95% CI: 0.47-0.93) in pneumonia-specific mortality – 2 studies
  • Interpretation of these results is complicated by co-interventions

Treatment of Neonatal Pneumonia with Injectable Antibiotic Therapy Alone on Pneumonia-specific Mortality

  • Because no studies were identified evaluating injectable antibiotics alone, a Delphi panel of 20 experts was convened to estimate effect size (very low quality of evidence).75% reduction (70-81.25%) for injectable antibiotics on pneumonia-specific mortality in community setting

Treatment of Neonatal Pneumonia with Injectable Antibiotic Therapy Alone on Sepsis-specific Mortality

  • Because no studies were identified evaluating injectable antibiotics alone, a Delphi panel of 20 experts was convened to estimate effect size (very low quality of evidence).
  • 65% (IQR: 50-70%) reduction for injectable antibiotics on sepsis-specific mortality in community setting

Inpatient Hospital Management for Neonatal Infections

  • Although the quality of evidence is low, the recommendation for case management is strong, and this is standard practice globally.  Therefore, a Delphi panel of 20 experts was convened to estimate effect size.
  • 80% reduction (IQR: 75-85%) for sepsis-specific mortality (very low quality of evidence)
  • 90% reduction (IQR: 88.75-95%) for pneumonia-specific mortality (very low quality of evidence)

Intervention Recommendation

  • Oral antibiotics administered in the community are effective for neonatal pneumonia mortality reduction based on a meta-analysis, but expert opinion suggests much higher impact from injectable antibiotics in the community or primary care level and even higher for facility-based care.           

References from Zaidi Paper Cited Here

  1. Black RE, Cousens S, Johnson HL, Lawn JE, Rudan I, Bassani DG, Jha P, Campbell H, Walker CF, Cibulskis R, et al:  Global, regional, and national causes of child mortality in 2008: a systematic analysis.  Lancet 2010, 375(9730): 1969-1987.

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